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Successful autologous peripheral blood stem cell transplantation in a Jehovah's Witness with multiple myeloma: review of literature and recommendations for high-dose chemotherapy without support of allogeneic blood products.

Schmitt S, Mailaender V, Egerer G, Leo A, Becker S, Reinhardt P, Wiesneth M, Schrezenmeier H, Ho AD, Goldschmidt H, Moehler TM.
Department of Medicine V (Hematology/Oncology/Rheumatology), University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany, stefan.schmitt@med.uni-heidelberg.de.

We present a case report of a successful high-dose melphalan therapy and autologous stem cell transplantation without the use of allogeneic blood product support in a 70-year-old patient suffering from multiple myeloma.

Based on the experience in this case and thorough evaluation of the literature, we consider pre-transplant Hb level of 11-12 g/dl, platelet count higher than 70/nl, good WHO performance status of two and lower and informed consent as important eligibility criteria.

During cytopenia recommended supportive measures include growth factor support with erythropoietin and G-CSF, p.o. iron treatment as well as prophylactic use of anti-fibrinloytic agents.

Furthermore we discuss additional options that might be considered depending on the individual factors as e.g. pre-transplant collection and cryoconservation of autologous platelet concentrates. Moreover, an analysis of socio-economic issues regarding this procedure is presented.

We conclude that allogeneic blood product free transplantation is a feasible procedure that can be offered to the patients belonging to distinct religious groups refusing allogeneic blood products as Jehova s Witnesses and patients presenting other contraindications for transfusions.

PMID: 18317881 [PubMed - as supplied by publisher]

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Source: Successful autologous peripheral blood stem cell t...[Int J Hematol. 2008] - PubMed Result